Basic Information
Provider Information
NPI: 1528695228
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: DELANA
MiddleName: KAY
NamePrefix:  
NameSuffix:  
Credential: MSN, APRN, AGACNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6100 HARRIS PKWY
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761324101
CountryCode: US
TelephoneNumber: 8172504906
FaxNumber:  
Practice Location
Address1: 6100 HARRIS PKWY
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761324101
CountryCode: US
TelephoneNumber: 8172504906
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/24/2020
LastUpdateDate: 03/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAP142765TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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